Methods and compositions for expanding long-term hematopoietic stem cell populations

ABSTRACT

The invention generally features compositions and methods for expanding long term hematopoietic stem cells (HSCs) in a population of cells. In particular, the invention relates to a method of expanding long term HSCs by culturing an initial population of HSCs with macrophages that promote self-renewal of long term HSCs. The expanded cell population provides a source of cells for therapeutic treatments utilizing HSC transplantation.

CROSS-REFERENCE TO RELATED APPLICATIONS

This application is a continuation of U.S. application Ser. No.14/903,548, filed Jan. 7, 2016, which claims the benefit of PCTApplication PCT/US2014/046498, filed Jul. 14, 2014, which claims thebenefit of U.S. provisional application No. 61/845,952, filed Jul. 12,2013, each of the disclosures of which are hereby incorporated byreference in its entirety.

GOVERNMENTAL RIGHTS

This invention was made with government support under R01A1080421awarded by the National Institute of Allergy and Infectious Disease. Thegovernment has certain rights in the invention.

FIELD OF THE INVENTION

The invention relates to compositions and methods for expandinglong-term hematopoietic stem cell (HSC) populations. In particular, theinvention relates to populations of cells with a substantial number oflong-term HSCs and culturing methods to expand numbers of long-term HSCsin cell populations.

BACKGROUND OF THE INVENTION

HSCs are responsible for sustaining hematopoietic homeostasis andregeneration after injury for the entire lifespan of an organism throughself-renewal, proliferation, differentiation, and mobilization. Themature cell contingent of adult hematopoietic tissue is continuouslyreplenished in the lifespan of an animal, due to periodical suppliesfrom HSCs that reside permanently in the niche. To maintain bloodhomeostasis, these primitive cells rely on two critical properties,namely multipotency and self-renewal. Multipotency enablesdifferentiation into multiple lineages, while self-renewal ensurespreservation of fate upon cellular division. During self-renewaldivision, an HSC is permitted to enter the cell cycle, while restrainedfrom engaging in differentiation, apoptosis or senescence pathways.

HSCs are rare cells that have been identified in fetal bone marrow,fetal liver, umbilical cord blood, adult bone marrow, and peripheralblood. HSCs are capable of differentiating into each of myeloerythroid(red blood cells, granulocytes, monocytes), megakaryocyte (platelets)and lymphoid (T-cells, B-cells, and natural killer cell lineages) cells.In addition, HSCs are long-lived and are capable of producing additionalstem cells (self-renewal). HSCs initially undergo differentiation andcommitment to lineage restricted hematopoietic progenitor cells (HPCs),which can be assayed by their ability to form colonies in semisolidmedia. HPCs are restricted in their ability to undergo multi-lineagedifferentiation and have lost the ability to self-renew. HPCs eventuallydifferentiate and mature into each of the functional elements of theblood.

HSC transplantation is the only curative therapeutic modality for avariety of hematological diseases. HSCs are also attractive target cellsfor delivery of genes and gene products to a recipient aftertransplantation. However, the potential use of HSCs has been limited dueto difficulties encountered with obtaining sufficient cell quantities,particularly for adult recipients and those without a matching donor.Furthermore, transplantation of insufficient HSC quantity results in anincreased risk of transplantation failure and risks of transplantationcomplications due to a delay in donor cell engraftment.

Extensive efforts have been invested to expand HSC populations ex vivo.HSCs have been cultured with various hematopoietic growth factors andcytokines, which usually result in the expansion of HPCs, but not HSCs.Ectopic expression of an HSC regulatory transcription factor (such asHoxB4) has been shown to lead to the expansion of HSCs ex vivo, but thesafety concern of cell transformation due to gene transfection limitsthis technique in clinical practice. HSCs have also been co-culturedwith other cell types, such as with endothelial cells, mesenchymal stemcells, or bone marrow stromal cells. While these cultures resulted inmaintenance or modest expansion of mouse HSC activity, they alsoresulted in the exhaustion of human long-term HSCs. Further, HSCs havebeen cultured with small molecules, such as SR-1, which have the abilityto promote HSC expansion, but the effects are relatively weak andrequire several weeks of culture to show an effect.

Despite such efforts to expand HSC populations, only limited success hasbeen achieved. Compositions and methods of expanding long-term HSCs in apopulation of cells are needed to further medical research and providetherapeutic treatments for conditions and diseases of the hematopoieticsystem.

SUMMARY OF THE INVENTION

In an aspect, the present invention is directed to an isolatedpopulation of cells. The isolated population of cells comprises at leastone hematopoietic stem cell (HSC) and at least one macrophage cell. Themacrophage cell promotes HSC expansion.

In another aspect, the present invention is directed to a method ofexpanding an isolated population of HSCs. The method comprises culturinga starter cell population including HSCs, adding macrophages to thestarter cell population to form an expanding HSC population, andculturing the expanding HSC population to form an expanded HSCpopulation. The number of long term HSCs is increased in comparison tothe number of long term HSCs in the starter cell population.

In still another aspect, the present invention is directed to atherapeutic composition. The therapeutic composition comprises ex vivoexpanded long term HSCs. The expanded long term HSCs were co-culturedwith macrophages.

In yet still another aspect, the present invention is directed to amethod of preparing a therapeutic composition for transientlyreconstituting hematopoiesis in a subject. The method comprisesculturing a starting cell population including HSCs ex vivo in a culturecomprising macrophages to expand the HSCs within the cell population andresuspending the HSCs in a pharmaceutically acceptable medium suitablefor administration to a recipient subject.

In yet still another aspect, the present invention is directed to a kitcomprising a starter population including HSCs, macrophages and/orsecreted factors from macrophages capable of promoting HSC expansion,and a container and a kit comprising macrophages and/or secreted factorsfrom macrophages capable of promoting HSC expansion and a container.

In another aspect, the present invention is directed to an isolatedpopulation of cells. The isolated population of cells comprises at leastone hematopoietic stem cell (HSC) and at least one macrophage derivedsecretion factor. The macrophage-derived secretion factor promotes HSCexpansion.

In still another aspect, the present invention is directed to a methodof expanding an isolated population of HSCs. The method comprisesculturing a starter cell population including HSCs, adding at least onemacrophage-derived secretion factor to the starter cell population toform an expanding HSC population, and culturing the expanding HSCpopulation to form an expanded HSC population. The number of long termHSCs is increased in comparison to the number of long term HSCs in thestarter cell population.

In still yet another aspect, the present invention is directed to atherapeutic composition. The therapeutic composition comprises ex vivoexpanded long term HSCs. The expanded long term HSCs were co-culturedwith at least one macrophage-derived secretion factor.

In yet still another aspect, the present invention is directed to amethod of preparing a therapeutic composition for transientlyreconstituting hematopoiesis in a subject. The method comprisesculturing a starting cell population including HSCs ex vivo in a culturecomprising at least one macrophage-derived secretion factor to expandthe HSCs within the cell population and resuspending the HSCs in apharmaceutically acceptable medium suitable for administration to arecipient subject.

BRIEF DESCRIPTION OF THE DRAWINGS

FIG. 1A, FIG. 1B, FIG. 1C, FIG. 1D, FIG. 1E and FIG. 1F show thepromotion of HSC ex vivo expansion by macrophages. FIG. 1A graphicallydepicts the gating strategies used to isolate bone marrow Gr-1 highmonocytes (Gr-1^(hi) MCs) (FIG. 1A, I), Gr-1^(low) monocytes (Gr-1^(low)MCs) (FIG. 1B, IV), and macrophages (Mϕ) (FIG. 1C, V). The number oftotal cells (FIG. 1D), HSC-enriched Lineage negative, Sca-1 positive,and c-kit positive (Lin⁻ Sca1⁺ c-kit⁺ or LSK) cells (FIG. 1E), and foldof expansion of LSK cells (FIG. 1F) present in cell cultures comparingthe effect of monocytes and macrophages on the expansion of HSCs ex vivoare graphically depicted. Cells without expansion culture (Input) andcultured without macrophages (W/O Mϕ) were included as controls.

FIG. 2A, FIG. 2B and FIG. 2C show that macrophages isolated from bonemarrow (BM-Mϕ)), spleen (SP-Mϕ)), and peritoneal cavity (PC-Mϕ) canpromote LSK cell expansion ex vivo. The number of total cells (FIG. 2A),LSK cells (FIG. 2B) and fold of expansion of LSK cells (FIG. 2C) aregraphically depicted for HSC expansion cultures including macrophagesisolated from different tissues. Cells without expansion culture (Input)and cultured without macrophages (W/O Mϕ) were included as controls.

FIG. 3A, FIG. 3B, FIG. 3C, FIG. 3D and FIG. 3E graphically illustratethat M2-polarized macrophages promote and M1-polarized macrophagesinhibit ex vivo expansion of HSCs. The number of total cells (FIG. 3A),LSK cells (FIG. 3B), and fold of expansion of LSK cells (FIG. 3C) aregraphically depicted for HSC expansion cultures including unpolarized(Mϕ)), M1 polarized (M1-Mϕ), and M2 polarized (M2-Mϕ) macrophages. FIG.3D graphically illustrates the ex vivo expansion of 5-week CobblestoneArea Forming Cells (CAFCs) representing long term HSCs from LSK cellscultured with unpolarized (Mϕ), M1 polarized (M1-Mϕ), and M2 (M2-Mϕ)polarized macrophages. Further, FIG. 3E shows that the fold expansion of5-week CACFs representing long term HSCs from LSK cells cultured withunpolarized (Mϕ), M1 polarized (M1-Mϕ), and M2 (M2-Mϕ) polarizedmacrophages when compared to that of input LSK cells without expansionculture. Cells cultured without macrophages (W/O Mϕ) were included as acontrol.

FIG. 4A, FIG. 4B, FIG. 4C, FIG. 4D, and FIG. 4E graphically illustratethe effect of macrophages on HSC ex vivo expansion with or withoutdirect contact. The number of total cells (FIG. 4A), LSK cells (FIG.4B), fold of expansion of LSK cells (FIG. 4C), CAFCs of the expandedcells (FIG. 4D) and fold of expansion of CAFCs (FIG. 4E) are graphicallydepicted for co-cultures of HSCs with macrophages (M1-polarized,M2-polarized or not polarized) in a transwell (+) to avoid cell-cellcontact or a regular culture plate (−) which allows direct cell-cellinteraction and without macrophages (W/O Mϕ). Cells without expansionculture (Input) were included as a control.

FIG. 5A, FIG. 5B, FIG. 5C, FIG. 5D, FIG. 5E, FIG. 5F, FIG. 5G and FIG.5H graphically illustrate the engraftment ability of LSK cells culturedwith macrophages (Mϕ) or M2 polarized macrophages (M2-Mϕ) increasessignificantly after transplanted into lethality irradiated recipientscompared to freshly isolated HSC cells (Input), whereas the engraftmentability of the cells cultured without macrophages (W/O Mϕ) or with M1polarized macrophages (M1-Mϕ) was reduced (FIG. 5A) aftertransplantation. The engraftment of T lymphocytes (T cells; FIG. 5B), BLymphocytes (B cells; FIG. 5C), and myeloid cells (M cells; FIG. 5D) isillustrated in FIG. 5B-D. During second transplantation, only LSK cellscultured with M2-Mϕ showed enhanced engraftment ability than the freshlyisolated HSC cells (FIG. 5E). The engraftment of T lymphocytes (T cells;FIG. 5F), B Lymphocytes (B cells; FIG. 5G), and myeloid cells (M cells;FIG. 5H) in the secondary transplantation recipients is illustrated inFIG. 5F-H.

FIG. 6A and FIG. 6B graphically illustrate that the frequency ofcompetitive repopulating units (CRU) was dramatically increased afterbeing co-cultured with M2-Mϕ. The short term CRU (two months) frequencyof input cells is 1/133, while the short term CRU frequency ofco-cultured cells is 1/7.87 (FIG. 6A). The long term CRU (four months)frequency of input cells is 1/293, while the long term CRU frequency ofco-cultured cells is 1/22.7 (FIG. 6B).

FIG. 7A, FIG. 7B, FIG. 7C and FIG. 7D graphically illustrate[[s]] thathuman M2 polarized macrophages induce human cord blood CD34⁺ cellsexpansion in vitro. Fold expansion of total cells (FIG. 7A), fold ofexpansion of CD34⁺ cells (FIG. 7B), CAFCs of the expanded cells (FIG.7C) and fold of expansion of CAFCs (FIG. 7D) are graphically depictedfor co-cultures of CD34⁺ cells with M2 polarized macrophages. Cellscultured without macrophages (W/O Mϕ) were included as a control.

DETAILED DESCRIPTION OF THE INVENTION

Applicants have discovered compositions and methods related to expandingthe population of long-term HSCs in a cell population. In particular,the inventors have discovered that culturing HSCs in the presence ofmacrophages, or factors secreted by macrophages, promotes long-term HSCexpansion. Such culturing methods stimulate more rapid cell cycle entryof quiescent HSCs, shorten cycling time of activated HSCs, and inhibitHSC senescence. Collectively, these effects lead to a more robustexpansion of HSCs in a much shorter time than conventional methods.Accordingly, the present invention is related to compositions andmethods useful in research and therapy for conditions and diseasesassociated with the hematopoietic system.

Various aspects of the invention are described in further detail in thefollowing subsections.

I. Compositions

In one aspect, the present invention is directed to an isolatedpopulation of cells comprising at least one hematopoietic stem cell(HSC) and at least one macrophage cell, wherein the macrophage cellpromotes HSC expansion.

In another aspect, the present invention is directed to a method ofexpanding an isolated population of HSCs comprising culturing a startercell population including HSCs, adding macrophages to the starter cellpopulation to form an expanding HSC population, and culturing theexpanding HSC population to form an expanded HSC population, wherein thenumber of long-term HSCs is increased in comparison to the number oflong-term HSCs in the starter cell population.

(a) Hematopoietic Stem Cells

The cell types relevant to the present disclosure are those of thehematopoietic system, particularly HSCs. Descriptions of cells hereinwill use those known to the skilled artisan, with the understanding thatthese descriptions reflect the current state of knowledge in the art andthe invention is not limited thereby to only those phenotypic markersdescribed herein.

HSCs are pluripotent stem cells capable of self-renewal and arecharacterized by their ability to give rise under permissive conditionsto all cell types of the hematopoietic system. HSC self-renewal refersto the ability of an HSC cell to divide and produce at least onedaughter cell with the same self-renewal ability and differentiationpotential of a HSC; that is, self-renewal cell division gives rise toadditional HSCs. Self-renewal provides a continual source ofundifferentiated stem cells for replenishment of the hematopoieticsystem. HSCs are identified by their small size, lack of lineage (lin)markers, low staining (side population) with vital dyes such asrhodamine 123 (rhodamine^(DULL), also called rho^(low)) or Hoechst33342, and presence of various antigenic markers on their surface. Themarker phenotypes useful for identifying HSCs will be those commonlyknown in the art. For human HSCs, the cell marker phenotypes preferablyinclude CD34⁺ CD38^(low) CD90(Thy1)^(low) Lin⁻. In another embodiment,the cell marker for human HSCs may include: CD34⁺ CD59⁺ CD90(Thy1)⁺CD38^(low/−) c-kit(CD117)⁺lin⁻. For mouse HSCs, an exemplary cell markerphenotype is Sca1⁺ CD90^(low) (see, e.g., Spangrude, G. J. et al.,Science 1:661-673 (1988)) or Lin⁻ Sca1⁺ c-kit⁺Thy1^(low) (see, Uchida,N. et al., J. Clin. Invest. 101(5):961-966 (1998)). In anotherembodiment, the cell marker for mouse HSCs may include: lin⁻CD34^(low/−) CD150+CD135⁻ CD48⁻Thy1^(+/low) Sca1⁺ c-kit⁺. AlternativeHSC markers such as aldehyde dehydrogenase (see Storms et al., Proc.Nat'l Acad. Sci. 96:9118-23 (1999) and AC133 (see Yin et al., Blood90:5002-12 (1997) may also find advantageous use.

HSCs may be short-term HSCs or long-term HSCs. “Short-term hematopoieticstem cell” or “ST-HSC” refers to hematopoietic stem cells that havelimited, short term self-renewing capacity, and are characterized bytheir capacity to differentiate into cells of the myeloid and lymphoidlineage. ST-HSC are distinguished from “long-term HSCs” (“LT-HSC”) bytheir limited length of self-renewal activity in vivo and in cultureassays. LT-HSCs are capable of self-renewal. Markers may be used todistinguish long-term from short-term HSCs. In a specific embodiment, anHSC of the invention is a long-term HSC.

i. Source

Cells of the present invention may be isolated from any stem cellcapable of giving rise to HSCs. Such stem cells include embryonic stemcells, adult stem cells, induced pluripotent stem cells, or cellstrans-differentiated from other cell types. In an embodiment, cells maybe isolated from embryonic stem cells, adult stem cells, inducedpluripotent stem cells, stem cells trans-differentiated from other celltypes, or combinations thereof. In a specific embodiment, cells may beisolated from adult stem cells. In another specific embodiment, cellsmay be isolated from embryonic stem cells. In still another specificembodiment, cells may be isolated from induced pluripotent stem cells.HSCs may be differentiated from the isolated cells. For example, HSCsmay be differentiated from isolated embryonic stem cells, adult stemcells, induced pluripotent stem cells, stem cells trans-differentiatedfrom other cell types, or combinations thereof. In a specificembodiment, HSCs may be differentiated from isolated adult stem cells.In another specific embodiment, HSCs may be differentiated from isolatedembryonic stem cells. In still another specific embodiment, HSCs may bedifferentiated from isolated induced pluripotent stem cells.

HSCs for expansion may be obtained from a variety of sources, includingbone marrow, peripheral blood, cord blood, blood, placental tissue,tissue, including liver, particularly fetal liver, other sources knownto harbor HSCs, and combinations thereof. Peripheral and cord blood is arich source of HSCs and HPCs. In a specific embodiment, HSCs may beobtained from bone marrow. In another specific embodiment, HSCs may beobtained from cord blood.

Cells are obtained using methods known and commonly practiced in theart. For example, methods for preparing bone marrow cells are describedin Sutherland et al., Bone Marrow Processing and Purging: A PracticalGuide (Gee, A P. ed.), CRC Press Inc. (1991)). Umbilical cord blood orplacental cord blood is typically obtained by puncture of the umbilicalvein, in both term or preterm, before or after placental detachment(see, e.g., Turner, C. W. et al., Bone Marrow Transplant. 10:89 (1992);Bertolini, F. et al., J. Hematother. 4:29 (1995)). HSCs and HPCs mayalso be obtained from peripheral blood by leukopheresis, a procedure inwhich blood drawn from a suitable subject is processed by continuousflow centrifugation to remove white blood cells while the other bloodcomponents are returned to the donor. Another type of isolationprocedure is centrifugation through a medium of varying density.

The cells are derived from any animal species with a hematopoieticsystem, as generally described herein. Preferably, suitable animals willbe mammals, including, by way of example and not limitation, rodents,rabbits, canines, felines, pigs, horses, cows, primates (e.g., human),and the like. The cells for the expansion may be obtained from a singlesubject, or a plurality of subjects. A plurality refers to at least two(e.g., more than one) donors. When cells obtained are from a pluralityof donors, their relationships may be syngeneic, allogenenic, orxenogeneic, as defined herein. A preferred embodiment of the presentdisclosure is directed to a mixture of allogeneic HSCs obtained by theexpansion methods herein. The allogeneic cells may be expandedseparately and the cells mixed following expansion, or the cells mixedprior to expansion. In a specific embodiment, HSCs are from anallogeneic donor. In another specific embodiment HSCs are from aplurality of allogeneic donors.

Where applicable, HSCs and HPCs may be mobilized from the bone marrowinto the peripheral blood by prior administration of cytokines or drugsto the subject (see, e.g., Lapidot, T. et al., Exp. Hematol. 30:973-981(2002)). Cytokines and chemokines capable of inducing mobilizationinclude, by way of example and not limitation, granulocyte colonystimulating factor (G-CSF), granulocyte macrophage colony stimulatingfactor (GM-CSF), erythropoietin (EPO) (Kiessinger, A et al., Exp.Hematol. 23:609-612 (1995)), stem cell factor (SCF), AMD3100 (AnorMed,Vancouver, Canada), interleukin-8 (IL-8), and variants of these factors(e.g., pegfilgastrim, darbopoietin). Combinations of cytokines and/orchemokines, such as G-CSF and SCF or GM-CSF and G-CSF, can actsynergistically to promote mobilization and may be used to increase thenumber of HSCs and HPCs in the peripheral blood, particularly forsubjects who do not show efficient mobilization with a single cytokineor chemokine (Morris, C. et al., J. Haematol. 120: 413-423 (2003)).

Cytoablative agents can be used at inducing doses (i.e., cytoreductivedoses) to also mobilize HSCs, and are useful either alone or incombination with cytokines. This mode of mobilization is applicable whenthe subject is to undergo myeloablative treatment, and is carried outprior to the higher dose chemotherapy. Cytoreductive drugs formobilization, include, among others, cyclophosphamide, ifosfamide,etoposide, cytosine arabinoside, and carboplatin (Montillo, M. et al.,Leukemia 18:57-62 (2004); Dasgupta, A et al., J. Infusional Chemother.6:12 (1996); Wright, D. E. et al., Blood 97:(8):2278-2285 (2001)).

The cells for expansion may also be subjected to further selection andpurification, which may include both positive and negative selectionmethods, to obtain a substantially pure population of cells. In oneaspect, fluorescence activated cell sorting (FACS), also referred to asflow cytometry, is used to sort and analyze the different cellpopulations. Cells having the cellular markers specific for HSCs or HPCsare tagged with an antibody, or typically a mixture of antibodies, thatbind the cellular markers. Each antibody directed to a different markeris conjugated to a detectable molecule, particularly a fluorescent dyethat can be distinguished from other fluorescent dyes coupled to otherantibodies. A stream of tagged or “stained” cells is passed through alight source that excites the fluorochrome and the emission spectrumfrom the cells detected to determine the presence of a particularlabeled antibody. By concurrent detection of different fluorochromes,also referred to in the art as multicolor fluorescence cell sorting,cells displaying different sets of cell markers may be identified andisolated from other cells in the population. Other FACS parameters,including by way of example and not limitation, side scatter (SSC),forward scatter (FSC), and vital dye staining (e.g., with propidiumiodide) allow selection of cells based on size and viability. FACSsorting and analysis of HSCs and HPCs is described in, among others,U.S. Pat. Nos. 5,137,809, 5,750,397, 5,840,580; 6,465,249; Manz, M. G.et al., Proc. Natl. Acad. USA 99:11872-11877 (2002); and Akashi, K. etal., Nature 404(6774):193-197 (2000)). General guidance on fluorescenceactivated cell sorting is described in, for example, Shapiro, H. M.,Practical Flow Cytometry, 4th Ed., Wiley-Liss (2003) and Ormerod, M. G.,Flow Cytometry: A Practical Approach, 3rd Ed., Oxford University Press(2000).

Another method of isolating the initial cell populations uses a solid orinsoluble substrate to which is bound antibodies or ligands thatinteract with specific cell surface markers. In immunoadsorptiontechniques, cells are contacted with the substrate (e.g., column ofbeads, flasks, magnetic particles) containing the antibodies and anyunbound cells removed. Immunoadsorption techniques can be scaled up todeal directly with the large numbers of cells in a clinical harvest.Suitable substrates include, by way of example and not limitation,plastic, cellulose, dextran, polyacrylamide, agarose, and others knownin the art (e.g., Pharmacia Sepharose 6 MB macrobeads). When a solidsubstrate comprising magnetic or paramagnetic beads is used, cells boundto the beads can be readily isolated by a magnetic separator (see, e.g.,Kato, K. and Radbruch, A., Cytometry 14(4):38492 (1993); CD34+ directisolation kit, Miltenyi Biotec, Bergisch, Gladbach, Germany). Affinitychromatographic cell separations typically involve passing a suspensionof cells over a support bearing a selective ligand immobilized to itssurface. The ligand interacts with its specific target molecule on thecell and is captured on the matrix. The bound cell is released by theaddition of an elution agent to the running buffer of the column and thefree cell is washed through the column and harvested as a homogeneouspopulation. As apparent to the skilled artisan, adsorption techniquesare not limited to those employing specific antibodies, and may usenonspecific adsorption. For example, adsorption to silica is a simpleprocedure for removing phagocytes from cell preparations.

FACS and most batch wise immunoadsorption techniques can be adapted toboth positive and negative selection procedures (see, e.g., U.S. Pat.No. 5,877,299). In positive selection, the desired cells are labeledwith antibodies and removed away from the remaining unlabeled/unwantedcells. In negative selection, the unwanted cells are labeled andremoved. Another type of negative selection that can be employed is useof antibody/complement treatment or immunotoxins to remove unwantedcells.

It is to be understood that the purification of cells also includescombinations of the methods described above. A typical combination maycomprise an initial procedure that is effective in removing the bulk ofunwanted cells and cellular material, for example leukapharesis. Asecond step may include isolation of cells expressing a marker common toone or more of the progenitor cell populations by immunoadsorption onantibodies bound to a substrate. For example, magnetic beads containinganti-CD34 antibodies are able to bind and capture HSCs, common myeloidprogenitors (CMPs), and granulocyte-monocyte progenitors (GMP) thatcommonly express the CD34 antigen. An additional step providing higherresolution of different cell types, such as FACS sorting with antibodiesto a set of specific cellular markers, can be used to obtainsubstantially pure populations of the desired cells. Another combinationmay involve an initial separation using magnetic beads bound withanti-CD34 antibodies followed by an additional round of purificationwith FACS. Cells may be purified such that the starting cell populationis purified HSCs. In a specific embodiment, purified HSCs are isolatedCD34⁺ cells. In another specific embodiment, purified HSCs are isolatedCD34⁺ CD90⁺ cells. In still another specific embodiment, purified HSCsare isolated CD34⁺ CD90⁺ c-kit⁺ cells. In still yet another specificembodiment, markers for purifying HSCs may be one or more markersselected from the group consisting of CD34⁺ or CD34^(low), Lin⁻,CD38^(low), CD90^(low) or CD90⁺, CD59⁺, c-kit⁺, Sca1⁺, Thy1^(low) orThy1⁺, CD150⁺, CD135⁻, and CD48⁻. Purification of cells may result in asubstantially pure population of long-term HSCs. The term “substantiallypure”, may be used herein to describe a purified population of HSCs thatis enriched for long-term HSCs, but wherein the population of long-termHSCs are not necessarily in a pure form. Accordingly, a “substantiallypure cell population” refers to a population of cells having a specifiedcell marker characteristic and differentiation potential that is atleast about 50%, preferably at least about 75-80%, more preferably atleast about 85-90%, and most preferably at least about 95% of the cellsmaking up the total cell population. Thus, a “substantially pure cellpopulation” refers to a population of cells that contain fewer thanabout 50%, preferably fewer than about 20-25%, more preferably fewerthan about 10-15%, and most preferably fewer than about 5% of cells thatdo not display a specified marker characteristic and differentiationpotential under designated assay conditions.

Determining the differentiation potential of cells, and thus the type ofHSCs or HPCs isolated, is typically conducted by exposing the cells toconditions that permit development into various terminallydifferentiated cells. These conditions generally comprise a mixture ofcytokines and growth factors in a culture medium permissive fordevelopment of the myeloid or lymphoid lineage. Colony forming cultureassays rely on culturing the cells in vitro via limiting dilution andassessing the types of cells that arise from their continueddevelopment. A common assay of this type is based on methylcellulosemedium supplemented with cytokines (e.g., MethoCult, Stem CellTechnologies, Vancouver, Canada; Kennedy, M. et al., Nature 386:488-493(1997)). Cytokine and growth factor formulations permissive fordifferentiation in the hematopoietic pathway are described in Manz etal., Proc. Natl. Acad. Sci. USA 99(18): 11872-11877 (2002); U.S. Pat.No. 6,465,249; and Akashi, K. et al., Nature 404(6774):193-197 (2000)).Cytokines include SCF (stem cell factor), FLT-3 ligand, GM-CSF, IL-3,TPO (thrombopoietin), and EPO (erythropoietin). Another in vitro assayis CAFC (cobblestone area-forming cell) assay or long-term cultureinitiating cell (LTC-IC) assay, which typically uses stromal cells tosupport hematopoiesis (see, e.g., Ploemacher, R. E. et al., Blood.74:2755-2763 (1989); and Sutherland, H. J. et al., Proc. Natl. Acad.Sci. USA 87:3745 (1995)).

Another type of assay suitable for determining the differentiationpotential of isolated cells relies upon in vivo administration of cellsinto a host animal and assessment of the repopulation of thehematopoietic system. The recipient is immunocompromised orimmunodeficient to limit rejection and permit acceptance of allogeneicor xenogeneic cell transplants. A useful animal system of this kind isthe NOD/SCID mice (Pflumio, F. et al., Blood 88:3731 (1996); SzilvassymS. J. et al., “Hematopoietic Stem Cell Protocol,” in Methods inMolecular Medicine, Humana Press (2002); Greiner, D. L. et al., StemCells 16(3):166-177 (1998); Piacibello, W. et al., Blood93:(11):3736-3749 (1999)) or Rag2 deficient mouse (Shinkai, Y. et al.,Cell 68:855-867 (1992)). Cells originating from the infused cells areassessed by recovering cells from the bone marrow, spleen, or blood ofthe host animal and determining presence of cells displaying specificcellular markers, (i.e., marker phenotyping) typically by FACS analysis.Detection of markers specific to the transplanted cells permitsdistinguishing between endogenous and transplanted cells. For example,antibodies specific to human forms of the cell markers (e.g., HLAantigens) identify human cells when they are transplanted into asuitable immunodeficient mouse.

The HSCs may be used directly for expansion or may be frozen for use ata later date. The HSCs may be frozen individually or together withmacrophages (described below) prior to co-culturing. A variety ofmediums and protocols for freezing cells are known in the art.Generally, the freezing medium comprises 5-10% dimethyl sulfoxide(DMSO), 10-50% serum, and 50-90% culture medium. Preferably, thefreezing medium comprises 5-10% DMSO, 10-20% serum, and 70-85% culturemedium. Other additives useful for preserving cells include, by way ofexample and not limitation, disaccharides such as trehalose(Scheinkonig, C. et al., Bone Marrow Transplant. 34(6):531-6 (2004)), ora plasma volume expander, such as hetastarch (i.e., hydroxyethylstarch). In some embodiments, isotonic buffer solutions, such asphosphate-buffered saline, may be used. An exemplary cryopreservativecomposition has cell-culture medium with 4% HSA, 7.5% DMSO, and 2%hetastarch. Other compositions and methods for cryopreservation are wellknown and described in the art (see, e.g., Broxmeyer, H. E. et al.,Proc. Natl. Acad. Sci. USA 100(2).645-650 (2003)). Cells are preservedat a final temperature of less than about −135° C.

(b) Macrophages

A macrophage of the present invention may be any macrophage type capableof promoting HSC self-renewal or expansion of HSCs. In a specificembodiment, a macrophage may promote expansion of long-term HSCs.

Macrophages are cells produced by the differentiation of monocytes intissues. Macrophages undergo specific differentiation depending on thelocal tissue environment. Macrophages can be phenotypically polarized bythe microenvironment to mount specific functional programs. Two distinctstates of polarized activation for macrophages have been defined: theclassically activated (M1) macrophage phenotype and the alternativelyactivated (M2) macrophage phenotype. Granulocyte macrophage colonystimulating factor (GM-CSF) and macrophage colony stimulating factor(M-CSF) are involved in the differentiation of monocytes to macrophages.Human GM-CSF can polarize monocytes towards the M1 macrophage subtypewith a “pro-inflammatory” cytokine profile (e.g. TNF, IL-23). Whereas,treatment with M-CSF produces an “anti-inflammatory” cytokine (e.g.IL-10) profile similar to M2 macrophages. The role of the classicallyactivated (M1) macrophage is an effector cell in T_(H)1 cellular immuneresponses, whereas the alternatively activated (M2) macrophage appearsto be involved in immunosuppression and wound healing/tissue repair. LPSand the T_(H)1 cytokine IFN-gamma polarize macrophages towards the M1phenotype which induces the macrophage to produce large amounts of TNF,IL-12, and IL-23. In contrast, exposure of macrophages to the T_(H)2cytokine IL-4 produces a M2 phenotype which induces the production ofhigh levels of IL-10 and IL-1 RA, and low expression of IL-12. M2macrophages can be further divided into subsets: M2a, M2b, and M2c basedon gene expression profiles. A third subset of activated macrophages,called regulatory macrophages or M2d macrophages, dampens immuneresponses by producing the immunosuppressive cytokine, IL-10. Regulatorymacrophages are induced by a variety of stimuli includingglucocorticoids released from adrenal cells and prostaglandins. Amacrophage of the invention may be an unpolarized macrophage, a M1polarized macrophage, a M2 polarized macrophage, or combinationsthereof. In a specific embodiment, a macrophage may be a M2 polarizedmacrophage. A M1 polarized macrophage may be stimulated or activated byIFN-gamma, TNF-alpha, LPS, or combinations thereof. A M2 polarizedmacrophage may be stimulated or activated by IL-4, IL-13, ICs (immunecomplexes), LPS, LTR, IL-1R, IL-10, TGF-beta, GCs, IL-6, LIF (leukocyteinhibitory factor), MCF, or combinations thereof. In a specificembodiment, a M1 polarized macrophage is stimulated or activated byIFN-gamma. In another specific embodiment, a M2 polarized macrophage isstimulated or activated by IL-4. A macrophage of the invention may bepolarized after isolation of the macrophage. Alternatively, a macrophageof the invention may be isolated as a polarized macrophage.

Macrophages may be found at points where microbial invasion oraccumulation of foreign particles are likely to occur. Each type ofmacrophage, determined by its location, has a specific name. Suitablemacrophages may include, but are not limited to, adipose tissuemacrophages, monocytes, Kupffer cells, sinus histiocytes, alveolarmacrophages, tissue macrophages, Langerhans cells, microglias, Hofbauercells, intraglomerular mesangial cells, osteoclasts, epthelioid cells,red pulp macrophages or peritoneal macrophages. Non-limiting examples ofa tissue comprising macrophages include adipose tissue, bone marrow,blood, liver, lymph node, pulmonary alveolus, connective tissue, skin,mucosa, central nervous system, placenta, kidney, bone, granuloma,spleen, or peritoneal cavity. In specific embodiments, a macrophage ofthe invention may be from the blood, the bone marrow, the spleen, theperitoneal cavity, or combinations thereof. In other specificembodiments, a macrophage of the invention may be a monocyte, a red pulpmacrophage, a peritoneal macrophage, or combinations thereof. In anembodiment where a monocyte is from the bone marrow, macrophagecolony-stimulating factor (M-CSF) may be used to differentiate themonocytes into mature macrophages. In another embodiment, macrophagesmay be derived from cord blood cells, peripheral blood cells, bonemarrow cells, placental cells, tissue cells, embryonic stem cells, adultstem cells, inducible pluripotent stem cells, stem cellstrans-differentiated from other cells, or combinations thereof. In aspecific embodiment, macrophages may be derived from cord blood cells.

Macrophages may be isolated according to methods standard in the art.For example, see Zhang et al., Curr Protoc Immunol, 2008, CHAPTER:Unit-14.1. Additionally, macrophages may be isolated according tomethods described in Section I(a). Macrophages can be identified byspecific expression of a number of proteins including, but not limitedto, CD14, CD40, CD11b, CD64, F4/80 (mice)/EMR1 (human), lysozyme M,MAC-1/MAC-3, CD68, CSF1R, MAC-2, CD11c, LY6C, IL-4Ra and CD163 by flowcytometry or immunohistochemical staining. Flow cytometry may be used toisolate macrophages from other hematopoietic cells. Generally, acombination of antibodies against several cell-specific antigens may beused to identify macrophages. In an embodiment, CD11b and F4/80/EMR1 maybe used to isolate macrophages. In another embodiment, CD11b,F4/80/EMR1, and CD68 may be used to isolate macrophages. In stillanother embodiment, one or more surface markers may be used to isolatemacrophages. The one or more surface markers may include, but is notlimited to, CD204, CD36, CD14, CD18, CD11b, CD64, CD32, CD16, CD88,CD303, CD209, CD205, CD282, CD284, CD80 and CD86. In a specificembodiment, cord blood mononuclear cells may be isolated from whichCD34⁻ cells may be further isolated. The isolated CD34⁻ cells may bedifferentiated to macrophages. Macrophage differentiation may occur byincubation with SCF and M-CSF.

The macrophages may be used directly for expansion or may be frozen foruse at a later date. The macrophages may be frozen individually ortogether with HSCs prior to co-culturing. A variety of mediums andprotocols for freezing cells are known in the art. Generally, thefreezing medium comprises 5-10% dimethyl sulfoxide (DMSO), 10-50% serum,and 50-90% culture medium. Preferably, the freezing medium comprises5-10% DMSO, 10-20% serum, and 70-85% culture medium. Other additivesuseful for preserving cells include, by way of example and notlimitation, disaccharides such as trehalose (Scheinkonig, C. et al.,Bone Marrow Transplant. 34(6):531-6 (2004)), or a plasma volumeexpander, such as hetastarch (i.e., hydroxyethyl starch). In someembodiments, isotonic buffer solutions, such as phosphate-bufferedsaline, may be used. An exemplary cryopreservative composition hascell-culture medium with 4% HSA, 7.5% DMSO, and 2% hetastarch. Othercompositions and methods for cryopreservation are well known anddescribed in the art (see, e.g., Broxmeyer, H. E. et al., Proc. Natl.Acad. Sci. USA 100(2).645-650 (2003)). Cells are preserved at a finaltemperature of less than about −135° C.

(c) Contacting

In one aspect, HSCs are co-cultured with macrophages to promote HSCexpansion. In another aspect, HSCs are contacted with at least onemacrophage-derived secretion factor that promotes HSC expansion. Instill another aspect, HSCs may be co-cultured with macrophages andcontacted with additional factors to promote HSC expansion.

HSCs, described in Section I(a), are co-cultured with macrophages,described in Section I(b). HSCs and macrophages may be co-cultured at a1:1 ratio. Alternatively, HSCs and macrophages may be co-cultured at aratio less than 1:1. For example, the ratio of HSCs to macrophages maybe about 1:1000, about 1:500, about 1:100, about 1:50, about 1:10, orabout 1:5. In a specific embodiment, the ratio of HSCs to macrophagesmay be about 1:50. Alternatively, HSCs and macrophages may beco-cultured at a ratio greater than 1:1. For example, the ratio of HSCsto macrophages may be about 100:1, about 50:1, about 10:1, or about 5:1.

Cells of the present invention may be contacted with additional factorsto promote expansion. Such additional factors include cytokines, growthfactors, polypeptides, proteins, small molecules, genes, expressionvectors, nutrients, and other factors known in the art or yet to bediscovered. Suitable factors may include macrophage-derived secretionfactors that promote HSC expansion. Macrophage-derived secretion factorsmay be isolated by methods known in the art. For example,macrophage-derived secretion factors may be isolated from macrophagecultures in which the macrophages have been removed, for example byfiltering or centrifugation. A skilled artisan will recognize thenumerous additional factors known in the art for promoting expansion ofstem cells. A preferred additional factor may be an additional factorthat can stimulate HSC self-renewal proliferation and/or inhibit HSCdifferentiation, apoptosis and senescence. In one aspect, the cells ofthe present invention are contacted with no more than 10 additionalfactors. In another aspect, the cells of the present invention arecontacted with no more than 9, 8, 7, 6, 5, 4, or 3 additional factors.In yet another aspect, the cells of the present invention are contactedwith no more than 3 additional factors. In still yet another aspect, thecells of the present invention are contacted with no more than 2additional factors. In a specific embodiment, the cells of the presentinvention are contacted with TPO and SCF. In another specificembodiment, the cells of the present invention are contacted with TPO,SCF and Flt-3 ligand. A skilled artisan would be able to determine theamount of additional factor to be added to promote expansion. In anembodiment, cells of the present invention may be contacted with about10 to about 100 ng/ml of TPO, SCF and/or Flt-3 ligand. For example,cells of the present invention may be contacted with about 10, about 20,about 30, about 40, about 50, about 60, about 70, about 80, about 90, orabout 100 ng/ml of TPO, SCF and Flt-3 ligand. In a specific embodiment,cells of the present invention may be contacted with 20 ng/ml of TPO andSCF. In another specific embodiment, cells of the present invention maybe contacted with 50 ng/ml of TPO, SCF and Flt-3 ligand.

(d) Expanding a Population of HSCs

One aspect of the invention includes methods of expanding a populationof HSCs, the methods include culturing a starter cell populationincluding HSCs; adding macrophages to the starter cell population toform an expanding HSC population; and culturing the expanding HSCpopulation to form an expanded HSC population, wherein the number oflong term HSCs is increased in comparison to the number of long termHSCs in the starter cell population.

The starter cell population may be a population obtained as described inSection I(a). The starter cell population of cells are contacted with abasal medium and cultured to expand the population of HSCs. The basalmedium may contain a mixture of additional factors such as cytokines andgrowth factors. The starter population may comprise additional factorsas described in Section I(c). In one aspect, the basal medium includesamino acids, carbon sources (e.g., pyruvate, glucose, etc.), vitamins,serum proteins (e.g., albumin), inorganic salts, divalent cations,antibiotics, buffers, and other preferably defined components thatsupport expansion of HSCs. Suitable basal mediums include, withoutlimitation, RPMI medium, Iscove's medium, minimum essential medium,Dulbecco's Modified Eagles Medium, and others known in the art. Theformulations of these and other mediums will be apparent to the skilledartisan.

Expansion is done for from about 1 day to about 30 days, preferably fromabout 5 days to about 15 days, more preferably about 7 days to about 10days or until the indicated fold expansion. Such HSC expansion resultsin an increase of HSCs compared to the number of HSCs in the initialpopulation. In certain aspects, the HSC expansion results in an increaseof long-term HSCs compared to the number of long-term HSCs in theinitial population. In certain aspects, the HSC expansion results in anincrease of short-term HSCs compared to the number of short-term HSCs inthe initial population. In certain aspects, the HSC expansion results inan increase of long- and short-term HSCs compared to the number of long-and short-term HSCs in the initial population. Preferably, there is anincrease of 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17,18, 19, 20, 25, 30, 35, 40, 45, 50, 55, 60, 65, 70, 75, 80, 85, 90, 95or more fold. In certain aspects, there is an increase of about 1.5 to 5fold. In some aspects, there is an increase of about 1, 1.25, 1.5, 1.75,2.0, 2.25, 2.5, 2.75, 3.0, 3.5, 4.0, 4.5, or 5.0 fold.

(e) Therapeutic Composition

Following harvest and expansion, HSCs, HPCs, or a mixture of cells thatinclude these cells may be combined with pharmaceuticalcarriers/excipients known in the art to enhance preservation andmaintenance of the cells prior to administration. Accordingly, theexpanded HSCs may be formulated into a therapeutic composition. As such,the invention encompasses a therapeutic composition comprising ex vivoexpanded HSCs, wherein the expanded HSCs were co-cultured withmacrophages. In a specific embodiment, the invention encompasses atherapeutic composition comprising ex vivo expanded long-term HSCs,wherein the expanded long-term HSCs were co-cultured with macrophages.

In an aspect, a method of preparing a therapeutic composition fortransiently reconstituting hematopoiesis in a subject comprisesculturing a starting cell population including HSCs ex vivo in a culturecomprising macrophages to expand the HSCs within the cell population andresuspending the HSCs in a pharmaceutically acceptable medium suitablefor administration to a recipient subject.

Pharmaceutically acceptable mediums suitable for administration to asubject are known in the art. In some embodiments, cell compositions ofthe invention can be conveniently provided as sterile liquidpreparations, e.g., isotonic aqueous solutions, suspensions, emulsions,dispersions, or viscous compositions, which may be buffered to aselected pH. Liquid preparations are normally easier to prepare thangels, other viscous compositions, and solid compositions. Additionally,liquid compositions are somewhat more convenient to administer,especially by injection. Viscous compositions, on the other hand, can beformulated within the appropriate viscosity range to provide longercontact periods with specific tissues. Liquid or viscous compositionscan comprise carriers, which can be a solvent or dispersing mediumcontaining, for example, water, saline, phosphate buffered saline,polyol (for example, glycerol, propylene, glycol, liquid polyethyleneglycol, and the like) and suitable mixtures thereof.

Sterile injectable solutions can be prepared by incorporating theexpanded HSCs of the present invention in the required amount of theappropriate solvent with various amounts of the other ingredients, asdesired. Such compositions may be in admixture with a suitable carrier,diluent, or excipient such as sterile water, physiological saline,glucose, dextrose, or the like. The compositions can also belyophilized. The compositions can contain auxiliary substances such aswetting, dispersing, or emulsifying agents (e.g., methylcellulose), pHbuffering agents, gelling or viscosity enhancing additives,preservatives, flavoring agents, colors, and the like, depending uponthe route of administration and the preparation desired. Standard texts,such as “Remington's Pharmaceutical Science”, 17th edition, 1985,incorporated herein by reference, may be consulted to prepare suitablepreparations, without undue experimentation.

Various additives which enhance the stability and sterility of thecompositions, including antimicrobial preservatives, antioxidants,chelating agents, and buffers, may be added. Prevention of the action ofmicroorganisms can be ensured by various antibacterial and antifungalagents, for example, parabens, chlorobutanol, phenol, sorbic acid, andthe like. The compositions can be isotonic, i.e., they can have the sameosmotic pressure as blood and lacrimal fluid. The desired isotonicity ofthe compositions of this invention may be accomplished using sodiumchloride, or other pharmaceutically acceptable agents such as dextrose,boric acid, sodium tartrate, propylene glycol or other inorganic ororganic solutes. Sodium chloride is preferred particularly for bufferscontaining sodium ions.

In another aspect, the expanded long-term HSCs are cryopreserved in acryopreservation medium. The HSCs may be cryopreserved prior toresuspending in a pharmaceutically acceptable medium. Alternatively, thestarting cell population of HSCs may be cryopreserved prior to culturingin a culture comprising macrophages. A variety of mediums and protocolsfor freezing cells are known in the art. Generally, the freezing mediumcomprises 5-10% dimethyl sulfoxide (DMSO), 10-50% serum, and 50-90%culture medium. Preferably, the freezing medium comprises 5-10% DMSO,10-20% serum, and 70-85% culture medium. Other additives useful forpreserving cells include, by way of example and not limitation,disaccharides such as trehalose (Scheinkonig, C. et al., Bone MarrowTransplant. 34(6):531-6 (2004)), or a plasma volume expander, such ashetastarch (i.e., hydroxyethyl starch). In some embodiments, isotonicbuffer solutions, such as phosphate-buffered saline, may be used. Anexemplary cryopreservative composition has cell-culture medium with 4%HSA, 7.5% DMSO, and 2% hetastarch. Other compositions and methods forcryopreservation are well known and described in the art (see, e.g.,Broxmeyer, H. E. et al., Proc. Natl. Acad. Sci. USA 100(2).645-650(2003)). Cells are preserved at a final temperature of less than about−135° C.

II. Methods of Use

The methods of the present invention include methods of using theexpanded HSCs for HSC based therapies. Accordingly, the methods of theinvention may be used to treat a disease or disorder in which it isdesirable to increase the number of HSCs or their progenitors.Frequently, subjects in need of the inventive treatment methods will bethose undergoing or expecting to undergo a blood cell (e.g., an immunecell) depleting treatment, such as chemotherapy.

Thus, methods of the invention may be used, for example, to treatpatients requiring a bone marrow transplant or a HSC transplant (e.g.,to reconstitute the hematopoietic system/tissue), such as cancerpatients undergoing chemotherapy and/or radiation therapy. Disorderstreated by methods of the invention may be the result of an undesiredside effect or complication of another primary treatment, such asradiation therapy, chemotherapy, or treatment with a bone marrowsuppressive drug. Methods of the invention may further be used as ameans to increase the number of mature cells derived from HSCs (e.g.,erythrocytes, lymphocytes). For example, disorders or diseasescharacterized by a lack of, or low levels of, blood cells, or a defectin blood cells, may be treated by increasing the pool of HSCs. Suchconditions include, for example, pancytopenia, neutropenia,thrombocytopenia, anemia and lymphopenia. The disorder to be treated mayalso be the result of an infection causing damage to blood/lymphoidcells and/or stem cells.

In one aspect, the methods of the invention include administering theexpanded HSCs to reconstitute the hematopoietic system or tissue of asubject. In another aspect, the methods include administering theexpanded HSCs to a subject for hematopoietic stem cell transplantation.Another aspect includes administering the expanded HSCs to a subject forincreasing the number of blood cells in a subject. In still anotheraspect, the present invention includes a method for reconstituting thehematopoietic system or tissue of a subject. Such methods includeadministering to a recipient subject an HSC population of the presentinvention.

The expanded HSCs may be administered to a subject as a mixture of HSCsand other cell types, such as HPCs and macrophages. In another aspect,the expanded HSCs may be administered to a subject as a substantiallypure population of HSCs. In another aspect, the expanded HSCs may bedifferentiated into specific cell types and then administered to asubject.

Administered HSCs of the invention may be present in the recipientsubject at 1 month or more following administration. For example, HSCsof the invention may be present at 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, or12 months or more following administration. Administered HSCs may bepresent as donor-derived white bloods cells such as donor-derived Tcells, B cells and myeloid cells. Methods of detecting the presence ofdonor-derived cells are known in the art and may include flow cytometry.

In another aspect, the present invention provides a use of thecomposition of the present invention for hematopoietic stem celltransplantation. The present invention also provides a use of thecomposition of the present invention for reconstituting thehematopoietic system or tissue of a subject. In still another aspect,the present invention provides a use of the composition of the presentinvention for the preparation of a medicament for reconstituting thehematopoietic system or tissue of a subject. The present invention alsoprovides a use of the present invention for increasing the number ofblood cells in a subject.

As used herein, “subject” or “patient” is used interchangeably. Suitablesubjects include, but are not limited to, a human, a livestock animal, acompanion animal, a lab animal, and a zoological animal. In oneembodiment, the subject may be a rodent, e.g. a mouse, a rat, a guineapig, etc. In another embodiment, the subject may be a livestock animal.Non-limiting examples of suitable livestock animals may include pigs,cows, horses, goats, sheep, llamas and alpacas. In yet anotherembodiment, the subject may be a companion animal. Non-limiting examplesof companion animals may include pets such as dogs, cats, rabbits, andbirds. In yet another embodiment, the subject may be a zoologicalanimal. As used herein, a “zoological animal” refers to an animal thatmay be found in a zoo. Such animals may include non-human primates,large cats, wolves, and bears. In specific embodiments, the animal is alaboratory animal. Non-limiting examples of a laboratory animal mayinclude rodents, canines, felines, and non-human primates. In certainembodiments, the animal is a rodent. Non-limiting examples of rodentsmay include mice, rats, guinea pigs, etc. In a preferred embodiment, thesubject is human.

(a) Administration

HSCs, HPCs, or a mixture comprising such cell types may be administeredto a subject according to methods known in the art. Such compositionsmay be administered by any conventional route, including injection or bygradual infusion over time. The administration may, depending on thecomposition being administered, for example, be, pulmonary, intravenous,intraperitoneal, intramuscular, intracavity, subcutaneous, ortransdermal. The stem cells are administered in “effective amounts”, orthe amounts that either alone or together with further doses produce thedesired therapeutic response. Administered cells of the invention may beautologous (“self’) or heterologous/non-autologous (“non-self,” e.g.,allogeneic, syngeneic or xenogeneic). Generally, administration of thecells can occur within a short period of time following the expansion ofHSCs (e.g., 1, 2, 5, 10, 24, 48 hours, 1 week or 2 weeks after theexpansion)) and according to the requirements of each desired treatmentregimen. For example, where radiation or chemotherapy is conducted priorto administration, treatment, and transplantation of stem cells of theinvention should optimally be provided within about one month of thecessation of therapy. However, transplantation at later points aftertreatment has ceased may be done with derivable clinical outcomes.

The quantity of cells to be administered will vary for the subject beingtreated. The precise determination of what would be considered aneffective dose may be based on factors individual to each patient,including their size, age, sex, weight, and condition of the particularpatient. As few as 100-1000 cells may be administered for certaindesired applications among selected patients. Therefore, dosages can bereadily ascertained by those skilled in the art from this disclosure andthe knowledge in the art. The skilled artisan can readily determine theamount of cells and optional additives, vehicles, and/or carrier incompositions and to be administered in methods of the invention.

The pharmaceutical composition of the present invention is administeredin a manner compatible with the dosage formulation, and in atherapeutically effective amount, for example intravenously,intraperitoneally, intramuscularly, subcutaneously, and intradermally.It may also be administered by any of the other numerous techniquesknown to those of skill in the art, see for example the latest editionof Remington's Pharmaceutical Science, the entire teachings of which areincorporated herein by reference. For example, for injections, thepharmaceutical composition of the present invention may be formulated inadequate solutions including but not limited to physiologicallycompatible buffers such as Hank's solution, Ringer's solution, or aphysiological saline buffer. The solutions may contain formulatoryagents such as suspending, stabilizing, and/or dispersing agents.Alternatively, the pharmaceutical composition of the present inventionmay be in powder form for combination with a suitable vehicle, e.g.,sterile pyrogen free water, before use. Further, the composition of thepresent invention may be administered per se or may be applied as anappropriate formulation together with pharmaceutically acceptablecarriers, diluents, or excipients that are well known in the art. Inaddition, other pharmaceutical delivery systems such as liposomes andemulsions that are well known in the art, and a sustained-releasesystem, such as semi-permeable matrices of solid polymers containing atherapeutic agent, may be employed. Various sustained-release materialshave been established and are well-known to one skilled in the art.Further, the composition of the present invention can be administeredalone or together with another therapy conventionally used for thetreatment of a disease/condition associated with poor expansion and/ordifferentiation of HSCs, or in which expansion and/or differentiation ofHSCs is desirable.

III. Kits

In another aspect, the disclosure provides kits containing initial cellsfor expansion, media and other necessary components for carrying out theex vivo expansion methods. Kits directed to use of the cell populations,expanded or unexpanded, for therapeutic applications are provided. Thekits may further include, by way of example and not limitation, buffers,labels, reagents, and instructions for methods of using the kits. In anembodiment, a kit may comprise a starter population including HSCs,macrophages and a container. In another embodiment, a kit may comprise astarter population including HSCs, secreted factors from macrophagescapable of promoting HSC expansion and a container. In still anotherembodiment, a kit may comprise macrophages and other components neededto expand HSCs ex vivo. Other components may include secreted factorsfrom macrophages capable of promoting HSC expansion.

Definitions

Unless defined otherwise, all technical and scientific terms used hereinhave the same meaning as is commonly understood by one of ordinary skillin the art. All patents, applications, published applications and otherpublications are incorporated by reference in their entirety. In theevent that there is a plurality of definitions for a term herein, thosein this section prevail unless stated otherwise.

“Allogeneic” refers to deriving from, originating in, or being membersof the same species, where the members are genetically related orgenetically unrelated but genetically similar. An “allogeneictransplant” refers to transfer of cells or organs from a donor to arecipient, where the recipient is the same species as the donor.

“Autologous” refers to deriving from or originating in the same subjector patient. An “autologous transplant” refers to the harvesting andreinfusion or transplant of a subject's own cells or organs. Exclusiveor supplemental use of autologous cells can eliminate or reduce manyadverse effects of administration of the cells back to the host,particular graft versus host reaction.

“Chemically-defined” as used herein refers to culture media of knownchemical composition, both quantitatively and qualitatively, with nodeliberately added uncharacterized supplements, even though such amedium may contain trace contaminants in its components. A chemicallydefined medium necessarily lacks animal serum, feeder cells such asstromal cells, and cell-based extracellular matrices derived from, e.g.,fibroblasts and the like.

“Cytokine” refers to compounds or compositions that in the natural stateare made by cells and affect physiological states of the cells thatproduce the cytokine (i.e., autocrine factors) or other cells. Cytokinealso encompasses any compounds or compositions made by recombinant orsynthetic processes, where the products of those processes haveidentical or similar structure and biological activity as the naturallyoccurring forms. Lymphokines refer to natural, synthetic, or recombinantforms of cytokines naturally produced by lymphocytes, including, but notlimited to, IL-1, IL-3, IL-4, IL-6, IL-11, and the like.

“Expansion” in the context of cells refers to increase in the number ofa characteristic cell type, or cell types, from an initial population ofcells, which may or may not be identical. The initial cells used forexpansion need not be the same as the cells generated from expansion.For instance, the expanded cells may be produced by growth anddifferentiation of the initial population of cells. Excluded from theterm expansion are limiting dilution assays used to characterize thedifferentiation potential of cells. As used herein, “expansion” and“self-renewal” are used interchangeably and refer to the propagation ofa cell or cells without terminal differentiation and “differentiation”refers to the developmental process of lineage commitment. A “lineage”refers to a pathway of cellular development, in which precursor or“progenitor” cells undergo progressive physiological changes to become aspecified cell type having a characteristic function (e.g., a T cell, amacrophage). Differentiation occurs in stages, whereby cells graduallybecome more specified until they reach full maturity.

“Growth factor” refers to a compound or composition that in the naturalstate affects cell proliferation, cell survival, and/or differentiation.A growth factor, while having the indicated effect on the cell, may alsoaffect other physiological process, such as secretion, adhesion,response to external stimuli, and the like. Although many growth factorsare made by cells, growth factors as used herein also encompass anycompound or composition made by recombinant or synthetic processes,where the product of those processes have identical or similar structureand biological activity as the naturally occurring growth factor.Examples of growth factors include epidermal growth factor (EGF),fibroblast growth factor (FGF), erythropoietin (EPO), thrombopoietin(TPO), stem cell factor (SCF), and flt-3 ligand (FL), and analogsthereof.

“Isolated” refers to a product, compound, or composition which isseparated from at least one other product, compound, or composition withwhich it is associated in its naturally occurring state, whether innature or as made synthetically.

“Hematopoietic stem cell” or “HSC” refers to a clonogenic, self-renewingpluripotent cell capable of ultimately differentiating into all celltypes of the hematopoietic system, including B cells T cells, NK cells,lymphoid dendritic cells, myeloid dendritic cells, granulocytes,macrophages, megakaryocytes, and erythroid cells. As with other cells ofthe hematopoietic system, HSCs are typically defined by the presence ofa characteristic set of cell markers.

“Enriched” when used in the context of HSC refers to a cell populationselected based on the presence of a single cell marker, generally CD34+,while “purified” in the context of HSC refers to a cell populationresulting from a selection on the basis of two or more markers,preferably CD34+CD90+.

“Myeloablative” or “myeloablation” refers to impairment or destructionof the hematopoietic system, typically by exposure to a cytotoxic agentor radiation. Myeloablation encompasses complete myeloablation broughton by high doses of cytotoxic agent or total body irradiation thatdestroys the hematopoietic system. It also includes a less than completemyeloablated state caused by non-myeloablative conditioning. Thus,non-myeloablative conditioning is treatment that does not completelydestroy the subject's hematopoietic system.

“Sorting” as it pertains to cells refers to separation of cells based onphysical characteristics (such as, e.g., elutriation or other size-basedtechniques) or presence of markers (such as sorting using side scatter(SSC) and forward scatter (FSC), or fluorescence activation cell sorting(FACS) using labeled antibodies), or analysis of cells based on presenceof cell markers, e.g., FACS without sorting, and including as wellimmunoabsorption techniques such as, e.g., magnetic cell separationsystems.

“Substantially pure cell population” refers to a population of cellshaving a specified cell marker characteristic and differentiationpotential that is at least about 50%, preferably at least about 75-80%,more preferably at least about 85-90%, and most preferably at leastabout 95% of the cells making up the total cell population. Thus, a“substantially pure cell population” refers to a population of cellsthat contain fewer than about 50%, preferably fewer than about 20-25%,more preferably fewer than about 10-15%, and most preferably fewer thanabout 5% of cells that do not display a specified marker characteristicand differentiation potential under designated assay conditions.

“Syngeneic” refers to deriving from, originating in, or being members ofthe same species that are genetically identical, particularly withrespect to antigens or immunological reactions. These include identicaltwins having matching MHC types. Thus, a “syngeneic transplant” refersto transfer of cells or organs from a donor to a recipient who isgenetically identical to the donor.

“Xenogeneic” refers to deriving from, originating in, or being membersof different species, e.g., human and rodent, human and swine, human andchimpanzee, etc. A “xenogeneic transplant” refers to transfer of cellsor organs from a donor to a recipient where the recipient is a speciesdifferent from that of the donor.

EXAMPLES

The following examples are simply intended to further illustrate andexplain the present invention. The invention, therefore, should not belimited to any of the details in these examples.

Example 1. Expansion of HSCs Ex Vivo in Co-Culture with Bone MarrowMonocytes and Macrophages

Isolation of mouse bone marrow cells (BMCs), mononuclear cells(BM-MNCs), lineage-negative hematopoietic cells (Lin⁻ cells), andHSC-enriched LSK cells.

The femora and tibiae were harvested from mice immediately after theywere euthanized with CO₂. BM cells were flushed from the bones into HBSScontaining 2% FCS using a 21-gauge needle and syringe. Cells from threeto ten mice were pooled and centrifuged through Histopaque 1083 (Sigma,St. Louis, Mo.) to isolate BM-MNCs. For the isolation of Lin⁻ cells,BM-MNCs were incubated with biotin-conjugated rat antibodies specificfor murine CD3, Mac-1, CD45R/B220, Ter-119, and Gr-1. The labeled maturelymphoid and myeloid cells were depleted twice by incubation with goatanti-rat IgG paramagnetic beads (Dynal Inc, Lake Success, NY) at abead:cell ratio of approximately 4:1. Cells binding the paramagneticbeads were removed with a magnetic field. The negatively isolated Lin⁻cells were washed twice with 2% FCS/HBSS and resuspended in completemedium (RPMI1640 medium supplemented with 10% FCS, 2 mM L-glutamine, 100HEPES buffer, and 100 U/ml penicillin and streptomycin) at 1×10⁶cells/ml. HSC-enriched LSK cells were sorted with an Aria II cell sorter(BD Biosciences, San Jose, Calif.) after Lin⁻ cells were preincubatedwith anti-CD16/32 antibody to block the Fcγ receptors and then stainedwith anti-Sca1-PE and c-Kit-APC-Cy7. Dead cells were excluded by gatingout the cells stained positive with propidium iodide (PI).

Isolation of bone marrow Gr-1^(high) monocytes (Gr-1^(hi) MCs),Gr-1^(low) monocytes MCs), (Gr-1^(low) MCs), and macrophages (Mϕ).Gr-1^(hi) MCs (FIG. 1A, I), Gr-1^(low) MCs (FIG. 1B, IV), andmacrophages (Mϕ) (FIG. 1C, V) were sorted with an Aria II cell sorterafter BMCs were stained with anti-Gr-1-PE, CD115-APC, and F4/80-FITCantibodies as shown in FIG. 1.

LSK cells (2×10³) were co-cultured with bone marrow Gr-1 MCs, Gr-1^(low)MCs, and macrophages (Mϕ) (1×10⁵) or cultured alone in a serum freemedium supplemented with 20 ng/ml of SCF and TPO for 5 days. The numberof total nucleated cells (FIG. 1D) and LSK cells (FIG. 1E) harvestedfrom the cultures were presented as absolute cell counts or foldexpansion compared to the input cells. The results show that LSK cellsexpanded about ˜8-fold in co-cultures with macrophages; whereas LSKcells decreased to about 40% of the input in cultures withoutmacrophages. Monocytes had no significant effect on LSK cell expansion(FIG. 1F).

Example 2. Expansion of HSCs Ex Vivo in Co-Culture with Macrophages fromDifferent Tissues

LSK cells (2×10³) were co-cultured with macrophages (1×10⁵) from thebone marrow (BM-Mϕ), peritoneal cavity (PC-Mϕ), and spleen (SP-Mϕ) orcultured without macrophages (W/O Mϕ) in a serum free mediumsupplemented with 20 ng/ml of SCF and TPO for 5 days. The number oftotal nucleated cells (FIG. 2A) and LSK cells (FIG. 2B) harvested fromthe cultures were presented as absolute cell counts compared to theinput cells. The results showed that LSK cells co-cultured with BM-Mϕ,SP-Mϕ, and PC-Mϕ expanded about 8.7-, 5.6-, and 14.4-fold, respectively,whereas the cells cultured without macrophages resulted in about 40%reduction in LSK cells (FIG. 2C).

Example 3. M2 but not M1 Polarized Macrophages Promote HSC Ex VivoExpansion

Macrophages were isolated from mouse peritoneal cavity. They werepolarized to M1 (M1-Mϕ) and M2 macrophages (M2-Mϕ) by incubation withIFN-γ (40 ng/ml) and IL-4 (40 ng/ml) overnight, respectively.Macrophages incubated with vehicle (PBS) overnight were included asunpolarized control macrophages (MC. LSK cells (2×10³) were co-culturedwith 1×10⁵M1-Mϕ, M2-Mϕ or Mϕ or without Mϕ (W/O Mϕ) as described inExample 2 above. After 5 days of incubation, cells were collected fromthe cultures and analyzed. The number of total nucleated cells (FIG. 3A)and LSK cells (FIG. 3B) harvested from the cultures were presented asabsolute cell counts. The fold expansion of LSK cells were presented inFIG. 3C in comparison with the input cells. The expansion of HSCs wasmeasured by 5-week CAFC assay (FIG. 3D,E). The results show that M2-Mϕwere more effective in promoting ex vivo expansion of HSCs according tothe CAFC assay than unpolarized macrophages (Mϕ) (FIG. 3D,E), eventhough they were less effective in promoting the expansion of totalcells and LSK cells (FIG. 3A-C). In contrast, M1-Mϕ inhibited HSCexpansion because LSK cells co-cultured with M1-Mϕ showed a significantreduction in the number of 5-week CAFCs (FIG. 3D,E).

Example 4. Both a Direct Contact with Macrophages and Soluble FactorsSecreted by Macrophages are Required to Promote In Vitro Expansion ofHSC Cells

Macrophages were isolated from mouse peritoneal cavity and polarized asdescribed above. LSK cells (2×10³) were co-cultured with 1×10⁵peritoneal M1 (M1-Mϕ) or M2 macrophages (M2-Mϕ) in a transwell plate (+)to avoid cell-cell direct contact or in a regular culture plate (−)which allows direct cell-cell interaction or without macrophages (W/OMϕ) in a serum free medium supplemented with 20 ng/ml of SCF and TPO for5 days. The number of total nucleated cells (FIG. 4A) and LSK cells(FIG. 4B) harvested from the cultures were presented as absolute cellcounts (FIG. 4A,B). The fold expansion of LSK cells were presented inFIG. 4C in comparison with the input cells. The results showed thatmacrophages can promote LSK cell expansion via cell-cell contact andmacrophage-derived soluble factors (FIG. 4). In addition, greater foldexpansions of HSCs were observed when LSK cells were co-cultured withunpolorazed macrophages (Mϕ) and M2-Mϕ in a non-transwell culture thanin a transwell culture, whereas the expansion of HSCs were suppressedless by M1-Mϕ in a transwell culture than in a non-transwell culture,according to the CAFC assay (FIG. 4D,E).

Example 5. Effects of Mϕ, M1-Mϕ and M2-Mϕ on HSC Engraftment

Macrophages were isolated from mouse peritoneal cavity and polarized;and LSK cells (2×10³, from C57BL/6-CD45.2 mice) were co-cultured with1×10⁵ M1-Mϕ) M2-Mϕ or unpolarized macrophages (Mϕ) or withoutmacrophages (W/O Mϕ), as described above. After 5 days of expansion,cells were collected from all of these cultures. The expanded cells and2×10³ unexpanded LSK cells (Input) were injected into lethal irradiatedrecipients (C57BL/6-CD45.1 mice) along with 2×10⁵ competitive bonemarrow cells from C57BL/6-CD45.1 mice (n=5-6 mice/group). One, two, andfour months after transplantation, the peripheral blood was collectedfrom each recipient. They were analyzed by flow cytometry for donor cellengraftment after red blood cells were lysed and the cells were stainedwith FITC-conjugated anti-mouse CD45.2, APC-conjugated anti-mouseThy1.2, APC- and PE-conjugated anti-mouse B220, and PE-conjugatedanti-mouse GR-1 and CD11b antibodies. Percentages of total donor-derivedwhite blood cells, and donor-derived T, B, and myeloid (M) cells arepresented in FIG. 5A-D. In addition, the primary recipients weresacrificed four months after transplantation to harvest bone marrowcells. One million of these bone marrow cells were then injected intolethally irradiated secondary recipients (C57BL/6-CD45.1). One, two, andthree months after the secondary transplantation, the peripheral bloodwas collected and analyzed for donor cell engraftment as described aboveby flow cytometry. Percentages of total donor-derived white blood cells,and donor-derived T, B, and myeloid (M) cells in the secondaryrecipients are presented in FIG. 5E-H.

Example 6. M2-Mϕ Increases the Competitive Repopulating Units (CRUs) ofHSCs after Ex Vivo Expansion

Lethally irradiated congenic (C57BL/6-CD45.1) recipient mice (n=6) werereconstituted with 25, 50, 100, or 200 LSK cells freshly isolated fromC57BL/6-CD45.2 mice or the progeny of 4.2, 8.5, 17, or 34 CD45.2 LSKcells harvested from a 10-day co-culture with M2-Mϕ as described abovealong with 200,000 whole bone marrow cells from C57BL/6-CD45.1 mice.Peripheral blood donor cell engraftments in the recipients were analyzedas described above by flow cytometry. If the percentage of donor-derivedcells in the blood from a recipient is less than 1% and/or fails to showmultilineage differentiation, the transplant is considered negative forengraftment. The data is presented as percentage of negative engraftmentin FIG. 6A,B. Calculation of CRU according to poisson distributiondemonstrates that co-culture with M2-Mϕ increased short term CRUs from1/133 LSK to 1/7.8 LSK, and long term CRUs from 1/293 LSK to 1/22.7 LSK,representing 17- and 13-fold expansion, respectively.

Example 7. Co-Culture with M2-Mϕ Promotes Ex Vivo Expansion of HumanCord Blood HSC/HPCs

Cord blood units were collected from cord blood cells bank of Universityof Arkansas For Medical Sciences. Cord blood mononuclear cells (CB-MNCs)were isolated by Ficoll-Hypaque density centrifugation, and CD34⁺ andCD34⁻ cells were isolated by an immunomagnetic selection kit (Myltenyi)according to the manufacturer's instructions. They were stored in liquidnitrogen in a frozen medium (DMEM+20% FBS+10% Dimethyl sulfoxide) untilbeing used. After thawing quickly and washed once with PBS, CD34⁻ cells(2×10⁶ per well) were differentiated to macrophages in a 12 well platewith a macrophage differentiation culture medium (DMEM+20% FBS+50 ng/mlhSCF+50 ng/ml hM-CSF) for 7 days. On day 8, 40 ng/ml hIL-4 was added tothe culture to polarize the differentiated macrophages into M2-Mϕovernight. On day 9, thawed CD34+ cells (1×10⁴ per well) were seeded tothe plate and cultured in human HSC expansion medium (a serum freemedium+ hSCF 50 ng/ml+hFlt-3 ligand 50 ng/ml+hTPO 50 ng/ml). Meanwhile,the same number of CD34+ cells was cultured in human HSC expansionmedium without macrophages as control (W/O Mϕ). After 7 days ofexpansion, the suspension cells were harvested from the culture tonumerate the total number of nucleated cells and analyze the frequenciesof CD34+ cells by flow cytometry after immunostaining withAPC-conjugated anti-human CD34 antibody. The fold expansion of totalnucleated cells and CD34+ cells was calculated and presented in FIGS. 7Aand 7B, respectively, in comparison with input CD34+ cells. In addition,fold expansion of HSCs was calculated according to the numbers of week-6CAFCs in input CD34+ cells and the progeny from expanded CD34+ cellsco-cultured with M2-Mϕ or without macrophages (W/O Mϕ) as shown in FIG.7C,D.

The invention illustratively disclosed herein suitably may be practicedin the absence of any element, which is not specifically disclosedherein. It is apparent to those skilled in the art, however, that manychanges, variations, modifications, other uses, and applications to themethod are possible, and also changes, variations, modifications, otheruses, and applications which do not depart from the spirit and scope ofthe invention are deemed to be covered by the invention, which islimited only by the claims which follow.

1. A therapeutic composition comprising ex vivo expanded long termhematopoietic stem cells (HSCs), wherein obtained HSCs were co-culturedwith M2 polarized macrophages and optionally at least onemacrophage-derived secretion factor thereby generating the ex vivoexpanded long term HSCs, wherein the HSCs have improved expansion andengraftment capabilities compared to HSCs expanded with non-polarizedmacrophages.
 3. The therapeutic composition of claim 1, wherein the exvivo expanded long term HSCs comprise a substantially pure population oflong-term HSCs.
 4. The therapeutic composition of claim 1, wherein theHSCs are obtained from the group consisting of bone marrow, peripheralblood, cord blood, blood, placental tissue, tissue, and combinationsthereof.
 5. The therapeutic composition of claim 1, wherein the HSCs aredifferentiated from isolated cells selected from the group consisting ofembryonic stem cells, adult stem cells, induced pluripotent stem cells,stem cells transdifferentiated from other cell types, and combinationsthereof.
 6. The therapeutic composition of claim 1, wherein themacrophages are isolated from blood, cord blood, bone marrow, spleen,peritoneal cavity, and combinations thereof.
 9. The therapeuticcomposition of claim 1, wherein the expanded long term HSCs arecryopreserved in a cryopreservation medium.
 10. A kit comprising: a) astarter population of HSCs b) M2 polarized macrophages and optionally atleast one macrophage-derived secretion factor; and c) a container. 11.The therapeutic composition of claim 1, wherein the HSCs are resuspendedin a pharmaceutically acceptable medium suitable for administration to arecipient subject.
 12. The therapeutic composition of claim 1, whereinthe HSCs are incorporated into a sterile injectable solution.